By: Tampa Injury Attorney, Martin J Hernandez

Although this has been the law for 4 years, not everyone understands the 14 day rule and how it affects them. There are two points that I often find clients lost on: the14-day rule and the Emergency Medical Condition rule.

PIP 14-Day Rule

Florida’s PIP statute governs the auto insurance that all drivers (except motorcyclists and cabs (but Uber and Lyft are required to carry)) are required to carry. The idea is to get every injured person in an auto accident medical coverage without having to fight over who is at fault (i.e., “no he ran the red light not me”). This why the coverage is sometimes referred to as ‘Florida No-Fault Insurance’. Read the language of § 627.736 here.

One of the new provisions has a major impact on thousands of Floridians: the 14-day rule or provision.

Because of Florida PIP, all drivers have insurance coverage which entitles them to have 80% of their medical expenses paid and 60% of lost wages paid, but these amounts cannot be more than $10,000 total. The statute, however, states that a motorist has 14 days after an automobile accident to seek medical treatment from either a hospital facility, emergency transport, medical doctor, doctor of osteopathy, chiropractor, or a dentist.

If you miss that 14-day window, you forfeited the PIP coverage that you have been paying for all along! This means that if the symptoms do not surface within the first two week period or you think you can deal with it, those injuries will not be covered.

The new law limits the amount insurance companies must pay for the claims submitted. Yes, that’s right. Insurance companies found a way not to pay for medical bills submitted; this is just the way they want it. Failure to meet the 14 day requirement means that the injured party must pay for the medical bills.

Because of these new provisions, insurance companies don’t have to cover as many people, increasing their profits.

Why the change? According to the Florida Office of Insurance Regulation, the justification for the change is to decrease PIP fraud. According to their study that justified the change in the law, personal injury protection fraud was a $600 million problem in the state of Florida. The intent was to combat PIP fraud so that premiums would go down. The idea was that those who are really injured will seek medical attention right away.

As to whether this change caused premiums to go down? You make the call if your auto insurance has gone down since 2012.

PIP Emergency Medical Condition (EMC)

The amended PIP Statute (Florida Statute §§ 627.736 and 627.732), left many physicians confused as to what truly constitutes such a condition. The amendment does expressly define an Emergency Medical Condition (EMC) as a medical condition: manifesting itself by acute symptoms of sufficient severity, which may include severe pain, such that the absence of immediate medical attention could reasonably be expected to result in any of the following:

Serious jeopardy to patient health,

Serious impairment to bodily functions,

Serious dysfunction of any bodily organ or part.

However, as you can tell, there is plenty of room for interpretation and clarity is not one of the law’s virtues.

The amended Florida “No-Fault” Statute went into effect on January 1, 2014, and expressly states that a finding of an EMC must take place in order for the claimant (injured person) to have access to the full $10,000 mentioned earlier.

If a physician determines that a claimant’s injuries do not meet the level of an EMC, then they are only entitled to just $2500 in PIP benefits for their medical treatment.

What makes the provision so confusing is that the statute does not make clear exactly how a medical professional is supposed to decide that an injured person has an EMC.

Contact an Experienced Florida PIP Attorney

At Fernandez and Hernandez, we have an experienced team of attorneys who battle insurance companies on a daily basis. Because of the changes made in 2012, it is now more difficult than ever to be reimbursed for damages as a result of an auto accident. Florida’s No-Fault insurance was supposed to make things easier. Instead, insurance companies have taken advantage of the recent changes to dispute and deny more and more claims.

Contact a personal injury attorney to discuss the specifics of your case and decide whether you need legal representation. A personal injury attorney could mean the difference between getting a settlement that barely covers your expenses or a settlement or verdict that pays all of your bills and allows you to get back to living your life.

At Fernandez & Hernandez, we understand that being seriously injured or suffering the sudden loss of a loved one is a traumatic and life changing event. If you or a loved one has been seriously injured by a distracted driver in the Tampa Bay area contact a personal injury lawyer at Fernandez & Hernandez to schedule a free consultation.

What is Florida “No Fault” or “PIP” Insurance?

When it comes to auto insurance, Florida is a “No-Fault” insurance state. This is an often misunderstood topic and what other people tell you it is, like most legal concepts, is usually wrong.

Drivers who are injured in a car accident in Florida and sometimes wonder why they are filing a “No-Fault” Claim under their own insurance policy when they are not at-fault. Those drivers incorrectly believe that because the other party is at-fault they should be paying all of the injured party’s medical bills. However, that is not the case. Why? Let’s change the facts around. What if both parties are blaming each other for the accident? For example, they both say that they had the green light. Yet, the injured party went to the hospital and incurred $5,000 in hospital bills (cheap for a Tampa hospital after a car accident). What if they missed two weeks of work ($2,000 in lost wages)? That means that the injured party is in the hole $7,000 for an accident that may not be their fault. The hospital is going to ask for payment from you because you are the patient and you are responsible for payment.

Hence, Florida No-Fault. You pay yours. I’ll pay mine. We’ll figure out later on who is responsible.

Now, under Florida law, every motorist is required to carry a minimum of $10,000 in Personal Injury Protection (PIP) coverage. A driver’s PIP coverage, as this type of insurance is most often known, is to cover medical bills and lost wages the driver may suffer in an accident, no matter who caused the accident. When a crash occurs, each person involved in the crash turns to his or her own insurance company to pay the costs of medical care and other losses.

Car Accidents under Florida’s No Fault Insurance Scheme What many drivers do not realize is that, under Florida’s no fault statute, their PIP coverage by law only covers 80% of the medical bills which they may incur in an accident as well as only 60% of lost wages or income they may suffer in a car accident. For example on how this works, assume you have a $10,000 PIP policy with a $1,000 deductible, the absolute minimum required under Florida law. You are hit by another driver in an accident in which the other driver is clearly at fault. Assume you go to the emergency room and your medical bills are $5,000 plus you are out of work for two weeks and lose out on $2,000 in income. Your car insurance will pay $4,000 to the hospital (leaving you a $1,000 co-pay) and pay you $1,200 of your lost wages. This way your bills are getting paid and you are not being sent to collections for the entire hospital bill.

But I shouldn’t pay the rest! Shouldn’t they pay for everything else?

Yes, they should and that’s how we can help. There are exceptions to Florida’s “No- Fault” law that permit a motorist to directly sue another motorist who caused the accident. The first exception to Florida’s no fault statute is if a person suffers a permanent injury as a result of the accident, Florida statute (627.737(2)) defines a permanent injury as: (i) significant and permanent loss of an important bodily function; (ii) permanent injury within a reasonable degree of medical probability, other than scarring or disfigurement; (iii) significant and permanent scarring or disfigurement; or (iv) death. Accordingly, if a driver suffers a “permanent injury” as defined above, then he is not subject to the “No-Fault” limitation against the at fault driver and may be able to bring a claim not only for medical bills and lost wages but also to recover for pain and suffering and other “intangible” damages suffered as a result of the accident. Another exception would be if the injuries suffered are not permanent, but the medical bills (or lost wages) total more than the $10,000 in PIP coverage. In that instance, a claim can be brought to recover the medical bills (or lost wages) not covered by the PIP insurance.

Obviously, even though Florida is a “No-Fault” state, the application of the law is limited since it only applies to those accidents in which the medical bills and/or lost wages or lost income do not exceed $10,000 and where someone has not suffered a permanent injury.

After A Car Accident: You may be injured and not know it. Ask yourself this: are you the same today physically as you were the day before the accident? Do you feel pain or just out of whack?

Injuries such as whiplash or “soft tissue” may not show any symptoms for hours, days, or even weeks later but the majority of medical professionals agree that the first 72 hours after an auto accident are the most critical and the time period during which treatment can be the most effective.

Believe it or not, the majority of auto accident injuries occur at speeds of 6 – 12 mph. This results in your car not showing much damage but your body might!

Often, a soft-tissue injury such as whiplash is permanent. Scar tissue can form in your muscles leaving them less flexible and prone to re-injury if you don’t receive proper treatment. If you are injured, your injuries typically will not heal on their own.

After an accident, get prompt medical attention. If you don’t get medical attention within the first 14-days, your benefits could be denied or limited, and your level of pain will likely increase. In most cases, treatment can cost you nothing out of pocket, even if the accident was your fault.

Don’t wait. Get help immediately.

If you do not have a doctor that can treat you after your car accident, we can recommend a doctor near your work or home or elsewhere that will work with you and get you feeling better.

IS FLORIDA NO FAULT GOING AWAY? IS PIP DEAD?

By your Tampa Auto Accident Attorney – Martin Hernandez

There is a movement in the Florida Legislature to repeal the state’s no-fault car insurance system after 47 years in place.

Florida is only one of 6 states that is still on the No-Fault system and, according to many, it is riddled with fraud and overbilling by doctors. The No-Fault or Personal Injury Protection (PIP) system cover injuries from car accidents, regardless of who is at-fault, up to $10,000. However, this number has not changed since 1971 and let’s face it, in 1971, you could buy a house for $10,000 and today, it is not even a down payment. Several attempts to fix the PIP system have yielded nothing except increased premiums and a silly 14-day rule that only increased the number of claims for emergency care. Yet, premiums have risen 25% from 2015 to 2017.

Other states repealed their No-Fault system and their premiums have gone down. For example, Colorado dropped their No-Fault system and their premiums went down by 35%. Florida drivers pay among the highest premiums in the nation for some of the lowest required coverage amounts.

Florida Legislature is now proposing going to an “at-fault” system and making bodily injury coverage mandatory which would make the “at-fault” driver’s insurance primary over the claims.

If you have been injured in a Tampa Car Accident and need a Tampa Injury Attorney, Get Lawyered Up Now and call Tampa Injury Attorney Martin Hernandez of Fernandez and Hernandez, LLC for a free consultation at 813-229-5353 or read more at: www.InjuryLawyersOfTampa.com

A car accident can turn your entire life upside down. Injuries can require hospitalization, surgery, and rehab. A crash can make you miss time from work or incur medical expenses. All for something that was not even your fault. When this happens, you need and deserve an experienced attorney who can represent you and get the justice you deserve. This isn’t your fault!

In Florida, vehicle owners are required to purchase protection which, in the event of an auto accident, will 80% of the first $10,000 of medical bills you incur. This law was put in place more than 40 years ago and has not changed since then. Well, 40 years ago you could buy a house for $10,000. Now, that is not even a down payment.

Unfortunately, PIP (Personal Injury Protection) may also limit your ability to take legal action, so it’s important to contact an experienced personal injury attorney immediately following an accident, especially if you have suffered a severe or disabling injury.

At Fernandez & Hernandez, LLC, our Tampa attorneys have decades of experience handling car accident claims and can evaluate your claim for the best course of action. Our lawyers will evaluate the difficulties you may face in recovering compensation.

Were you or a loved one severely injured in a car accident? If so, call Tampa Injury Attorney Martin Hernandez at 813-229-5353 or InjuryLawyerOfTampa.com

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